decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Clinical Lab Services / Fraud alerts / Fragmenting hospital lab bills
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Article Overview
This article reviews an OIG fraud alert focused on hospital laboratory billing fragmentation and related consulting arrangements. It explains the general compliance and investigative concerns raised by these practices, including their potential impact on Medicare billing integrity and hospital cost reporting. The piece is relevant to compliance staff, hospital revenue cycle teams, auditors, and investigators who monitor laboratory billing and fraud risk.
Why This Topic Matters
The article highlights a billing pattern that can create false claims exposure and broader program integrity concerns for hospitals and their consultants. It is useful for identifying the types of arrangements investigators may scrutinize and the compliance issues hospitals should be aware of.
Article Sections
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Fragmenting hospital lab bills
Discusses laboratory billing irregularities observed in hospitals and the role of consulting firms in promoting revenue-focused billing changes. It also covers broader concerns about hospital oversight, investigation, and program integrity.
What You Will Learn
- The general compliance concerns associated with fragmented hospital laboratory billing
- How consultant compensation arrangements can create billing integrity risks
- What investigators may look for when reviewing hospital laboratory billing practices
- How the alert frames hospital organizational accountability and documentation concerns
Who Should Read This
- Hospital compliance professionals
- Medical coders and billing staff
- Revenue cycle managers
- Audit and investigations teams
- Healthcare attorneys
- Fraud and abuse investigators
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